Nurses training program for Arrest management

1. WORK SHOP ON CODE
BLUE MANAGEMENT

2. Introduction
Godwin Sujin.G
B.Sc(N).,MBA(HM)
Quality Team
Dr.Jayaharan Memorial Hospital
Nagercoil

4.  A message announced over a hospital’s public
address system, indicating that a cardiac arrest
or respiratory arrestrequiring CPR is in progress;
to be“coded”is to undergo CPR.
 Dr.Jayaharan Memorial Hospital code to be
used by all staff to summon a trained
team of medical personnel to undertake
cardio-pulmonary resuscitation.

5. MET CODE BLUE
1. The patient is still responsive but
there is a sudden deterioration in
patient’s status
2. Respiratory distress
3. O2 saturation, Blood pressure, pulse
is gradually dropping/belownormal
1. The patient is unresponsive
2.No respiration
3.No pulse
What is the difference between Medical Emergency Team
(MET) from Code Blue ?

6. It is the sudden loss of
cardiac function, when
the heartabruptly stops
beating. Unless
resuscitative efforts
are begun
immediately, cardiac
arrest leads to death
within a few minutes.

8. Team of
providers sometimes
called a “code
team”being required to
rush to the specific
location and begin
immediate resuscitative
efforts in an
emergency situation
announced in a
hospital or

9. The First Responder is not
actually a member of a team but
is the person who identifies and
confirms cardiopulmonary arrest.

10. 1. Medical Specialist On Call/
ER Specialist for ER Code
 Assume overall responsibility or the direction
of activities.
 Communicate with event manager/recorder
 Issues all medical and resuscitative orders
including resuscitation medications.
 Termination of Code Blue and final disposition of
the patient.
 Communicate with patient’s family along with
Nursing Supervisor at the end of the code.
 Complete documentation for medical records.

11. 2. ICU Resident on Duty
 Manage the airway as directed
by the team leader
 Perform bag-mask ventilation
 Prepare and assist with
intubation
 Confirm ETT placement
 Secure ETT
 Complete documentation in the
medical record

12. 3. Anesthesia Resident
 Manage the airway if ICU
resident is delayed
 Respond to instructions from
Team Leader for changing
roles
 Complete documentation in
medical records

13. 4. Ward Staff on Duty in
charge of the patient
 Perform an continue chest
compression as instructed
by team leader.
 Hand over to Compressor
2 when tired.
 Complete documentation in
medical records

14. 5. Nursing Staff on Duty
 Relieves Compressor 1
when tired
 Complete documentation in
the medical record.

15. 6. Nursing Superintendent on Duty
 Help rapid transport of blood
samples to laboratory
 Manage crowd control with
security
 Communicate with the family
 Notify patient Affairs, Social
Worker, Interpreter
 Attend to pastoral needs of
the patient
 Coordinate patient transfer
and placement with team
leader.

16. 7. ICU Nurse
 Established vascular access
and ensure patency
 Administer IV medication
as per verbal order of
team leader
 Assist airway and
intubation
 Insert NGT as indicated

17. 8. Nursing Supervisior
 Ensure providers assume pre-
assigned roles and that the team
knows who is responsible for what
role
 Assign RN1 as recorder
 Assign RN2 to bring equipment
needed
 Once roles established, ensure
management of the rest remaining
work in the ward/unit.
 Ensure crowd control with the help
of security with in the room/ward.
 Notify the switch board if code is
over.

18. 9. Bedside Nurse (RN 1)
 Provide history using SBAR
communication
 Stay at bedside
 Ensure availability of
workplace
 Continue as the recorder
 Maintain accurate written
record of the timings of all
intervention.

19. SBAR
• What is SBAR Communication

20. 10. Ward Nurse (RN 2)
 Get and ready the crash
cart, other equipment such
as suction.
 Clearly state “I am getting…”
 Distribute code cart supplies
 Operate monitor/defibrillator
 Prepare medication according
to order from team leader
 Receive instruction from ICU
RN or team leader.

21. 11. Airway Management
 Helps ICU, anesthesia
residents in airway
management

22. CODE BLUE
R
N
2
R
N
1
ICU NURSE
COMP.2
COMP.1
EVENT MANAGER
OTHERS
OTHERS

23. Arrest Management

24. Chain Of Survival- Adult

25. Adult Basic Life Support

26. Adult Cardiac Arrest Algorithm

27. Adult Cardiac Arrest Circular
Algorithm

28. Post- Cardiac Arrest Care
Algorithm

29. Adult Brady cardia Algorithm

30. Adult Tachycardia With
A Pulse Algorithm

31. Pediatric Basic Life Support- Single
Rescuer

32. Pediatric Basic Life Support- 2 or More
Rescuer

33. Pediatric Cardiac ArrestAlgorithm

34. Neonatal Cardiac Arrest
Algorithm

35. CRASH CART

36. Always check the crash cart for
these emergency drugs (quantity,
expiration date) before starting
your shift.
“By failing to prepare you are preparing to
fail in your role of saving lives”

38. CODE BLUE FLOW SHEET

39. CODE BLUE PROGRESS NOTES

40. CODE BLUE QUALITY
REVIEW CHECK LIST

46. Initiation of Code Blue
1.The first responder, if not CPR
certified will:
Call for HELP and dial “9”
(Reception) to initiate CODE BLUE
providing the following information
slowly and clearly and repeating the
information if necessary:
o Responder identity
oThe location of the patient

47. 1. If first responder is BLS certified:
She/He will start CABs of CPR, attach
defibrillator immediately upon arrival of
this equipment and continue CPR until
code team arrives an team leader takes
over.

48. 1. Announce “ATTENTION …CODE
BLUE IN (area)” three times
clearly and bleep the Code Blue
team.
2. Continue to be attentive and direct
responders to the location.

49.  The team leader will identify self as
leader and start conducting the
procedures systematically after analyzing
the rhythm.
 Each member of the team will start
performing his/her role under guidance of
the team leader till told to stop.
 Any change in role will be as per direction
of the team leader and all must stay on
the scene till allowed by him.

50. Termination of Code Blue
1. It is decide by the team leader. If MRP
of the patient available on site, his/her
opinion can be sought in making this
decision.
1. The team leader will allow team
members to stand down an return to
regular duties, with exception of the
Medical Specialist an Nursing
supervisor who will asses an coordinate
further intervention, as required.

51. RULE #1
CALM DOWN and DON’T PANIC

54. CPR is as easy as C-A-B

55. Oral Intubation

72. We are hoping to see competent nurses
during code blue.